Uncontrollable Crying (and Laughter) With Multiple Sclerosis

I often say that I choose to laugh (whenever possible) because if I didn’t, I’d cry. Well, about 10% people living with multiple sclerosis don’t have that choice. They have a condition called pseudobublar affect, or PBA.

Some of you may have heard of PBA as a syndrome which is being experienced by an increasing number of veterans returning with traumatic brain injury (TBI) or maybe even stroke victims who have uncontrolled “emotional outbursts” of laughing or crying. Well, MS is one of the short list of neurological conditions (along with TBI, stroke and ALS) for which PBA is a relatively common co-morbidity.

It is said to have been Charles Darwin (yup, father of the Theory of Evolution Charles Darwin) who first described PBA as a medical condition over 130 years ago.

The disorder is often mistakenly associated with depression and other emotional conditions when it is, in fact, neurological in origin.

Now, the occasional feeling of being overwhelmed or dealing with profound fatigue can bring a person with MS to tears (or, I suppose nervous laughter). PBA isn’t that kind of uncontrolled emotion. People living with PBA can’t stop laughing/crying even if they try and can often not describe what brought on their outburst.

Five important criteria your doctors would want to know if you think you have PBA include:

1. The patient bursts out crying or laughing for no apparent reason.
2. The patient cries or laughs at inappropriate times.
3. The patient experiences outbursts of emotion that are exaggerated or inappropriate for the situation.
4. Patients can’t control their tears or laughter, even when they try to.
5. Patients may isolate themselves from going out in public out of fear of having an episode in public.

While treatment of PBA has often included the prescription of antidepressant drugs, a new drug therapy using Dextromethorphan plus low-dose Quinidine has not only proved relatively effective, but seems to even be tolerated well by MS patients taking disease modifying drugs.

I know one of the things that many of you find comforting in the pages of Life With MS Blog are the times when you read something and say (maybe even aloud), “I thought I was the only one”… Well, here’s another one for you.

Do you have symptoms that fit into the five criteria listed above? Have you talked to your docs about this condition? Might you now, after reading about it?

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ABOUT THE AUTHOR

Trevis Gleason

Trevis L. Gleason is a food journalist and published author, an award-winning chef and culinary instructor who has taught at institutions such as Cornell University, New England Culinary Institute and...read more